Provider Demographics
NPI:1518494996
Name:METRO EAST DERMATOLOGY & SKIN CANCER CENTER LLC
Entity Type:Organization
Organization Name:METRO EAST DERMATOLOGY & SKIN CANCER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-268-6330
Mailing Address - Street 1:331 REGENCY PARK
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1887
Mailing Address - Country:US
Mailing Address - Phone:618-622-7546
Mailing Address - Fax:618-227-0098
Practice Address - Street 1:331 REGENCY PARK
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-1887
Practice Address - Country:US
Practice Address - Phone:618-622-7546
Practice Address - Fax:618-227-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty